Provider Demographics
NPI:1942367115
Name:LOUISE H. BETHEA, M.D., PA
Entity Type:Organization
Organization Name:LOUISE H. BETHEA, M.D., PA
Other - Org Name:ALLERGY, ASTHMA AND IMMUNOLOGY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-580-6494
Mailing Address - Street 1:17070 RED OAK DR
Mailing Address - Street 2:107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2619
Mailing Address - Country:US
Mailing Address - Phone:281-580-6494
Mailing Address - Fax:
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2619
Practice Address - Country:US
Practice Address - Phone:281-580-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00935NMedicare ID - Type Unspecified
TXC13432Medicare UPIN